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Characterizing Safety and Clinical Outcomes Associated with High-Dose Micafungin Utilization in Patients with Proven Invasive Candidiasis
Micafungin is the empiric antifungal agent of choice for the treatment of invasive candidiasis (IC). Pathophysiologic changes that occur in obese and/or critically ill patients can alter micafungin serum concentrations and the probability of target attainment. Although high doses of micafungin have...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8878997/ https://www.ncbi.nlm.nih.gov/pubmed/35202218 http://dx.doi.org/10.3390/tropicalmed7020023 |
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author | Grant, Victoria C. Nguyen, Kenneth Rodriguez, Sasha Zhou, Anna Y. Abdul-Mutakabbir, Jacinda C. Tan, Karen K. |
author_facet | Grant, Victoria C. Nguyen, Kenneth Rodriguez, Sasha Zhou, Anna Y. Abdul-Mutakabbir, Jacinda C. Tan, Karen K. |
author_sort | Grant, Victoria C. |
collection | PubMed |
description | Micafungin is the empiric antifungal agent of choice for the treatment of invasive candidiasis (IC). Pathophysiologic changes that occur in obese and/or critically ill patients can alter micafungin serum concentrations and the probability of target attainment. Although high doses of micafungin have been shown to be safe, clinical outcomes have not been widely evaluated. We conducted a single-center, retrospective observational study evaluating safety and clinical outcomes among adult patients treated with ≥200 mg of micafungin for ≥3 days for proven IC from 1 September 2013 through 1 September 2021. Twenty-three unique encounters for 21 patients were evaluated. The median BMI and APACHE II scores were 37.1 (IQR 28.8–48.9) and 24 (IQR 17.7–31), respectively. The median average daily dose of micafungin was 300 mg (IQR 275–400). Patients were treated with high-dose (HD) micafungin for the entirety of their echinocandin course in 15 encounters (65.2%). Transaminases remained stable, while a trend towards increased alkaline phosphatase was observed. A total of four deaths occurred (17.4%). Patients that died were predominantly young, Hispanic males who were obese and/or critically ill. Future studies are needed to determine the necessity and appropriate placement of HD micafungin in obese and/or critically ill patients. |
format | Online Article Text |
id | pubmed-8878997 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-88789972022-02-26 Characterizing Safety and Clinical Outcomes Associated with High-Dose Micafungin Utilization in Patients with Proven Invasive Candidiasis Grant, Victoria C. Nguyen, Kenneth Rodriguez, Sasha Zhou, Anna Y. Abdul-Mutakabbir, Jacinda C. Tan, Karen K. Trop Med Infect Dis Brief Report Micafungin is the empiric antifungal agent of choice for the treatment of invasive candidiasis (IC). Pathophysiologic changes that occur in obese and/or critically ill patients can alter micafungin serum concentrations and the probability of target attainment. Although high doses of micafungin have been shown to be safe, clinical outcomes have not been widely evaluated. We conducted a single-center, retrospective observational study evaluating safety and clinical outcomes among adult patients treated with ≥200 mg of micafungin for ≥3 days for proven IC from 1 September 2013 through 1 September 2021. Twenty-three unique encounters for 21 patients were evaluated. The median BMI and APACHE II scores were 37.1 (IQR 28.8–48.9) and 24 (IQR 17.7–31), respectively. The median average daily dose of micafungin was 300 mg (IQR 275–400). Patients were treated with high-dose (HD) micafungin for the entirety of their echinocandin course in 15 encounters (65.2%). Transaminases remained stable, while a trend towards increased alkaline phosphatase was observed. A total of four deaths occurred (17.4%). Patients that died were predominantly young, Hispanic males who were obese and/or critically ill. Future studies are needed to determine the necessity and appropriate placement of HD micafungin in obese and/or critically ill patients. MDPI 2022-02-03 /pmc/articles/PMC8878997/ /pubmed/35202218 http://dx.doi.org/10.3390/tropicalmed7020023 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Brief Report Grant, Victoria C. Nguyen, Kenneth Rodriguez, Sasha Zhou, Anna Y. Abdul-Mutakabbir, Jacinda C. Tan, Karen K. Characterizing Safety and Clinical Outcomes Associated with High-Dose Micafungin Utilization in Patients with Proven Invasive Candidiasis |
title | Characterizing Safety and Clinical Outcomes Associated with High-Dose Micafungin Utilization in Patients with Proven Invasive Candidiasis |
title_full | Characterizing Safety and Clinical Outcomes Associated with High-Dose Micafungin Utilization in Patients with Proven Invasive Candidiasis |
title_fullStr | Characterizing Safety and Clinical Outcomes Associated with High-Dose Micafungin Utilization in Patients with Proven Invasive Candidiasis |
title_full_unstemmed | Characterizing Safety and Clinical Outcomes Associated with High-Dose Micafungin Utilization in Patients with Proven Invasive Candidiasis |
title_short | Characterizing Safety and Clinical Outcomes Associated with High-Dose Micafungin Utilization in Patients with Proven Invasive Candidiasis |
title_sort | characterizing safety and clinical outcomes associated with high-dose micafungin utilization in patients with proven invasive candidiasis |
topic | Brief Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8878997/ https://www.ncbi.nlm.nih.gov/pubmed/35202218 http://dx.doi.org/10.3390/tropicalmed7020023 |
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